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Background: The old age population, including the very old aged (≥ 85 years), is rapidly increasing, and femur neckfracture from accidents is commonly seen in the elderly. Use of bone cement during bipolar hemiarthroplasty can causebone cement implantation syndrome. Methods: This study was prospectively conducted on the elderly who were scheduled to undergo elective cemented bipolarhemiarthroplasty under spinal anesthesia. Patients were divided into 2 groups: the old age (65–84 years) and very oldage groups (≥ 85 years). Hemodynamic parameters were recorded at the following time points: the start of the operation,femoral reaming, cement insertion, every 2 minutes after cement insertion for 10 minutes, femoral joint reduction, andthe end of operation. When hypotension occurred, ephedrine was given. Results: Sixty-five patients in the old age group and 32 patients in the very old age group were enrolled. Mean ages were78.9 and 89.4 years, respectively, in the old age and very old age groups. The very old age group showed constantly decreasedlevels of cardiac index and stroke volume from cementing until the end of the operation compared to the old agegroup. To maintain hemodynamic stability after cement insertion, the requirement of ephedrine was higher in the veryold age group than in the old age group (13.52 ± 7.76 vs 8.65 ± 6.38 mg, P = 0.001). Conclusions: Bone cement implantation during bipolar hemiarthroplasty may cause more prominent hemodynamicchanges in very elderly patients. Careful hemodynamic monitoring and management are warranted in very elderly patientsundergoing cemented bipolar hemiarthroplasty.

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